Health policy experts are starting to look at what moving the United States to a pure government-run health finance system would do to the supply of care.
Witnesses talked about the impact of "single-payer" health finance proposals Thursday, at a hearing the Senate Budget Committee held on the "Medicare for all" proposals introduced by Sen. Bernie Sanders in the Senate and Rep. Pramila Jayapal, D-Wash., in the House.
On Thursday, Sanders introduced S. 4204, the Medicare for All Act of 2022 bill with 14 Democratic co-sponsors.
Sanders' bill would eliminate the current Medicare program, Medicaid and all current forms of private health insurance and create a government program that would pay for health care. It's similar to other single-payer health system bills Sanders has introduced in the past.
Congressional Budget Office Director Phillip Swagel suggested that, in single-payer health care scenarios the CBO analyzed, the increase in the gap between the amount of care promised and the amount of care actually delivered could be modest.
Charles Blahous, a domestic policy analyst at George Mason University's Mercatus Center, argued that the CBO analysts are too optimistic about how much a shift to a single-payer system would cut administrative costs.
In the real world, a single-payer system with a somewhat bigger administrative burden could end up meeting little of the newly created demand for health care, Blahous said at the hearing, which was held in Washington and streamed live on the web.
"Lawmakers would be very unlikely to tolerate that outcome and would probably address it by paying providers more," Blahous said.
Increasing provider pay could help close the care supply gap but make the new single-payer system much more expensive than proponents are predicting, Blahous said.
The Backdrop
Sanders — a Vermont independent who caucuses with the Democrats, and who chairs the Senate Budget Committee — argued that the case for shifting to a single-payer health care system is clear.
"The American people understand, as I do, that care is a human right, and not privilege," Sanders said.
The United States has a more expensive system than other countries, and 70 million Americans are either uninsured or underinsured, Sanders said.
"This is unacceptable," Sanders said. "This is un-American."
Sanders acknowledged that the kinds of "Medicare for all" bills he and Jayapal have introduced would be expensive.
"But, while providing comprehensive health care for all, it would be significantly less expensive than our current dysfunctional system," Sanders said.
Dr. Adam Gaffney, a critical care physician affiliated with Harvard's medical school, testified that private insurers, profits and overhead eat up 12% of current insurance premiums.
